Downloaded Graphics from “At the Crossroads: Providing Long-Term Services and Supports at a Time of High Demand and Fiscal Constraint”
Percent Change in State Tax Revenue 2007 (actual) to 2013 (projected) Personal Income, Corporate, and Sales Taxes WA VT NH ME MT ND MA MN OR ID SD WI NY MI RI WY CT PA NE IA NJ NV OH IN DE UT IL CO MD WV CA KS VA MO KY NC Percent Change TN AZ OK NM AR SC < -15.0% GA MS AL -9.9% to -14.9% LA TX -5.0% to -9.9% AK -0.0% to -4.9% FL 0.0% to 4.9% +5.0% to 9.9% HI > +10% Source: HMA analysis of data from National Association of State Budget Officers (NASBO), Fall Fiscal Survey of States, 2007–2010 reports, and Fall 2012 Report for 2013. Notes: Data are not adjusted for inflation. The 2013 figures are enacted. For Illinois, this map uses projected revenue from NASBO's 2006 report because 2007 revenue data were not available.
State Revenue Changes for 50 States through and beyond the Recession Percent change in state nominal revenue from 2007 baseline 80.0% 2008 : One 2010: All but 2013: Six year into the a handful of years later, recession, states have 16 states 60.0% 13 states revenues still have experience below the revenues budget 2007 lower than declines. baseline. 2007 levels. 40.0% 20.0% 0.0% -20.0% -40.0% 2008 2009 2010 2011 2012 2013 Source: Computed from data reported in National Association of State Budget Directors and National Governors' Association Fiscal Survey of the States, Spring 2012 for 2011, 2012, and 2013 (projected) and from Fiscal Survey of the States, Fall 2011 for 2010.
Cumulative Revenue Experience Average annual % difference from 2007 baseline 2008 to 2013 (projected) WA VT NH ME MT ND MA MN OR ID SD WI NY MI RI WY CT PA NE IA NJ NV IN OH DE UT IL MD WV CO CA KS VA MO KY NC TN AZ OK Average % Difference NM AR SC < -20% GA MS AL -10 % to -15% LA TX -5% to -10% 0% to -5% FL AK 0% to +5% +5% to +10% +15% to +20% > +20% HI Source: HMA analysis of data from National Association of State Budget Officers (NASBO), Fall Fiscal Survey of States, 2007–2012 reports. NOTE: The data are the average of each state’s percentage difference from the 2007 baseline revenue over the 6 years. No states fell within +10% to 15%, or -15% to -20% ranges.
Medicaid Enrollment Growth Has Slowed Significantly Medicaid annual enrollment growth 1998–2013 (projected) 11% 9.30% 9% 7.80% 7.50% 7.20% 7% 5.60% 4.40% 5% 4.30% 3.20% 3.20% 3.20% 3.10% 2.75% 3% 0.40% 1% 0.20% -1% -0.50% -1.90% -3% Source: "Medicaid Today; Preparing for Tomorrow: A Look at State Medicaid Program Spending, Enrollment and Policy Trends. Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2012 and 2013"; Vernon K. Smith, Kathleen Gifford, Eileen Ellis, et al.; Kaiser Commission on Medicaid and the Uninsured; October 2012. Note: Enrollment percentage changes from June to June of each year.
Annual Growth in Total and State Medical Spending, 2003–2013 27.5% 0.27 ARRA Enhanced FMAP (2009–2011) 0.22 16.1% 0.17 0.12 10.1% 9.7% 8.5% 7.7% 7.6% 6.4% 6.6% 5.8% 0.07 5.5% 5.7% 4.9% 4.0% 3.8% 3.8% 3.0% 2.3% 2.0% 1.3% 0.02 -0.03 Enhanced FMAP/Federal Fiscal Relief (2003–2005) -4.9% -0.08 -10.9% -0.13 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Adopted Total State General Fund Source: "Medicaid Today; Preparing for Tomorrow: A Look at State Medicaid Program Spending, Enrollment and Policy Trends. Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2012 and 2013"; Vernon K. Smith, Kathleen Gifford, Eileen Ellis, et al.; Kaiser Commission on Medicaid and the Uninsured; October 2012. Note: Years are state fiscal years.
HCBS Waiver Recipient Change 2010–2013 (projected) 3 2013 10 (projected) 34 4 2012 7 36 3 2011 7 27 3 2010 4 26 0 5 10 15 20 25 30 35 40 Number of States Decrease No Change Increase N = 33 for 2010 N = 37 for 2011 N = 47 for 2012 and 2013
HCBS Expenditure Change from Previous Year 2011–2013 2 2013 5 projected 37 7 2012 3 34 4 2011 1 29 0 10 20 30 40 Number of States Decrease Stay the Same Increase N = 34 for 2011 N = 44 for 2012 and 2013
Percent Change in HCBS Expenditures 2011–2012 2012–2013 WA NH WA VT ME MT ND NH VT ME MT ND MA MN MA OR MN WI OR ID SD NY WI ID SD NY MI RI WY MI RI CT WY PA CT NE IA NJ PA NV NE IA NJ IN OH DE NV UT IL IN OH DE UT IL CO MD WV CO CA KS VA WV MD CA KS VA MO KY MO KY NC NC TN TN AZ OK AZ OK NM AR SC NM AR SC GA MS MS GA AL AL LA LA TX TX FL FL AK AK HI HI District of Columbia expenditures increased Percent Change less than 5% District of Columbia expenditures decreased less than 5% +=>15% + 8% to 15% + 5% to 8% +< 5% No Change - <5% -5% to 8% -8% to 15%
Nursing Facility Census Change from Previous Year 2011–2013 18 2013 20 projected 7 18 2012 15 13 20 2011 9 7 0 5 10 15 20 25 Number of States Decrease Stay the Same Increase N = 36 for 2011 N = 46 for 2012 N = 45 for 2013
Nursing Facility Census Change 2011–2013 100% % of Total Responding States 80% 39.1% 40.0% 55.6% 60% 32.6% 40% 44.4% 25.0% 20% 28.3% 19.4% 15.6% 0% 2011 2012 2013 projected Census Increased Census Stayed the Same Census Decreased N = 36 for 2011 N = 46 for 2012 N = 45 for 2013
Funding Sources for State Aging and Disability Agencies State appropriation Older Americans Act Medicaid U.S. Department of Labor U.S. Department of Agriculture Social Services Block Grant Other Targeted tax Local (i.e., county or city) funding Foundation/private grants Community Services Block Grant U.S. Department of Transportation U.S. Department of Education State lottery Federal Emergency Management Agency (FEMA) U.S. Department of Justice 0 10 20 30 40 50 60 70 80 90 100 Percent of States
Non-Medicaid Expenditures (SFY 2012 vs. SFY 2013) 50.0% 45.0% 40.0% Percent of States 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Increased Decreased Stayed the same Do not know SFY 2012 Changes in Non-Medicaid Expenditures SFY 2013 Anticipated Changes in Non-Medicaid Expenditures
SFY 2011–2012 State by State Changes in Non-Medicaid Expenditures NH VT ME WA MA MT ND MN OR ID NY WI RI MI SD CT WY PA RI NJ IA OH NE DE NV IN IL UT VA WV MD CA CO KS MO DC KY NC TN OK SFY 2011–2012 Percent Change AZ SC AR NM GA 11%–15% Decrease AL MS LA 6%–10% Decrease TX 5% or less Decrease FL AK Stayed the Same 5% or less Increase HI 6%–10% Increase Data Not Available
SFY 2013 Anticipated State by State Changes in Non-Medicaid Expenditures NH VT ME WA MA MT ND MN OR NY ID WI RI MI SD CT WY PA RI NJ IA OH NE NV DE IN IL UT VA WV MD CA CO KS MO DC KY NC TN SFY 2012–2013 Percent Change AZ OK SC AR NM 11%–15% Decrease GA AL MS 6%–10% Decrease LA TX 5% or less Decrease FL Stayed the Same AK 5% or less Increase 6%–10% Increase HI Do Not Know Data Not Available
Strategies Used or Planned to Control Non-Medicaid Costs (SFY 2012 and SFY 2013) Streamline state-level operations Form new partnerships Reduce staff Limit enrollment Freeze or reduce provider rates Streamline regional and/or local operations Reduce state's allotments to AAA and local providers Limit services Delay implementation of new programs Increase cost-sharing (copayments/contributions) Change from more local service delivery to regional Eliminate programs Eliminate services 0 5 10 15 20 25 Number of States SFY 2012 SFY 2013
Change in APS Caseloads: SFY 2010–2012 Percent of Responding States 100% 80% 60% 40% 20% 0% 2010 2011 2012 Decreased Increased Stayed the same
Two-thirds of States Have or Are Planning Duals Integration Initiatives WA VT NH ME MT ND MA MN OR WI ID SD NY MI RI WY CT PA NE IA NJ NV IN OH DE UT IL CO MD WV CA KS VA MO KY NC TN AZ OK Implementation AR NM SC GA MS Existing Program AL (in 2012) LA TX Plan to Implement timing uncertain FL AK Plan to Implement in 2013 Plan to Implement in 2014 HI
State Duals Integration Finance Structure WA VT NH ME MT ND MA MN OR WI ID SD NY MI RI WY CT PA NE IA NJ NV IN OH DE UT IL CO MD WV CA KS VA MO KY NC TN AZ OK NM AR SC Implementation GA MS AL RBMC LA TX MFFS or PCCM FL AK Both RBMC and MFFS ACO Model HI
States Restructuring State Aging and Disability Agencies NH VT ME WA MA MT ND MN OR NY ID WI RI MI SD CT WY PA NJ IA OH NV NE DE IN IL VA UT WV MD CO CA MO KS DC KY NC TN AZ OK SC NM AR GA AL MS LA TX FL AK States restructuring since 2011 (CT, DE, HI, IA, IN, KS, ME, NC, NH, OH, OR, PA, VT, VA, WA, WY) HI States with plans for restructuring (CO, DC, LA, NV, WV) States both restructuring since 2011 and with plans (AL, MD, NJ)
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